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Filarial Hydrocele Workup

  • Author: Bradley Fields Schwartz, DO, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
Updated: Nov 17, 2014

Laboratory Studies

Laboratory tests and findings in filarial hydrocele are as follows:

  • Complete blood cell count (CBC): Patients with patent filarial infection commonly have marked eosinophilia
  • Serum immunoglobulins: Elevated serum levels of immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) are seen with microfilarial infection
  • Enzyme-linked immunoassay (ELISA): Og4C3 monoclonal antibody–based ELISA provides a quantitative measure of circulating filarial antigen (CFA)
  • Immunochromatographic testing (ICT): Dipstick testing of whole blood with ICT cards, which utilize monoclonal antibody AD.12, is a qualitative test for CFA that is widely used in the field as a screening test for lymphatic filariasis[6, 7]
  • Hydrocele fluid examination: CFA may be detected in hydrocele fluid,[8] and microfilariae may be found on cytology
  • Urine examination: Chyluria may be detected macroscopically, and microfilariae may be detected via microscopic examination of voided urine; proteinuria and hematuria may also be seen with microfilarial infection with renal involvement
  • Peripheral blood examination: Microfilariae may be detected via microscopic examination of peripheral blood; microfilariae demonstrate a circadian pattern that varies by endemic region, necessitating serum sampling that coincides with periods of activity; activity may be provoked with administration of DEC


Lymphatic obstruction can be demonstrated on ultrasonography. Motile adult worms may be seen in symptomatic and subclinical filarial hydroceles. The characteristic movements of adult filarial worms are called the filarial dance sign (FDS) and are a reliable diagnostic finding. Ultrasonography may also be used to monitor response to treatment.

Contributor Information and Disclosures

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.


Rizk El-Galley, MD, MB, BCh, FRCS Director of Clinical Research, Assistant Professor, Department of Surgery, Division of Urology, University of Alabama

Rizk El-Galley, MD, MB, BCh, FRCS is a member of the following medical societies: American Urological Association, Royal College of Surgeons of England, SWOG

Disclosure: Nothing to disclose.

Joe Miller, MD Staff Physician, Division of Urology, Southern Illinois University School of Medicine

Joe Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

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Filarial infection causing enlarged pubic lymph nodes.
Laparoscopic view of enlarged lymphatics secondary to filarial infection.
Lymphocele of the right spermatic cord.
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